Sleep and aggression in substance-abusing adolescents: Results from an integrative behavioral sleep-treatment pilot program

Study Objective: To examine whether change in total sleep time during an integrative, behavioral sleep intervention is associated with aggression. Specifically, we tested whether adolescents who reported experiencing aggressive thoughts or actions after treatment had worse treatment trajectories (e.g., less total sleep time across treatment) than adolescents with no aggressive thoughts or actions after treatment. Design: Nonpharmacologic open trial with 9 weeks of weekly assessment. Setting: University of Arizona Sleep Research Laboratory Patients or Participants: Twenty-three adolescents recently treated for substance abuse in outpatient community centers. Interventions: Six-week integrative, behavioral sleep intervention. Measurements and Results: Weekly sleep-summary indexes were calculated from daily sleep diaries and entered as dependent variables in a series of growth-curve analyses. Statistically significant Session × Post-treatment Aggressive Ideation interactions emerged when predicting changes in total sleep time, γ₁₃ = 9.76 (SE = 4.12), p < .05, and time spent in bed, γ₁₃ = 10.08, (SE = 4.33), p < .05, even after controlling for aggressive ideation and the frequency of substance use, as assessed at baseline. A similar pattern of results was seen for self-reported aggressive actions occurring during conflicts. Conclusions: These pilot data suggest that inadequate sleep in substance-abusing adolescents may contribute to the experiencing of aggressive thoughts and actions. Limitations include a small sample size and a restricted assessment of aggression. Nonetheless, these findings lend preliminary support to the breadth of therapeutic effectiveness of an integrative, behavioral sleep-therapy program for adolescents with a history of substance abuse and related behaviors.